Childbirth in Developing Countries

Kat Russell, November 13, 2011

For many women, childbirth is a natural and beautiful experience through which new life is brought into the world. But for women who live in developing countries such as Niger, India or Uganda, childbirth is a risky endeavor.

"We hear pregnancy is considered so natural and childbirth is considered a part of life, but there is a real sense of a complication and death," said Mary Beth Powers, chief of the Child Survival Campaign for Save the Children. "One out of seven women will face complications. That's a global figure."

Each year, approximately 529,000 women die during childbirth or from complications during pregnancy, and approximately 90 percent of these deaths occur in developing countries. The maternal death rate in these developing regions is approximately 300 times higher than those in developed countries.

The risk of a woman dying in pregnancy and childbirth depends on the number of pregnancies she has in her lifetime—the higher the number of pregnancies, the greater the risk of pregnancy-related death. Successive pregnancies—one too soon after the other another—does not give the mother adequate time to recover after losing nutrients such as iron and folate due to pregnancy and breastfeeding. This is called maternal depletion syndrome.

Back-to-back pregnancies can deplete the mother's essential nutrients, putting her at higher risk for anemia and other complications such as uterine rupture, which in turn puts babies at risk of low birth weight and preterm birth. In Niger, a woman gives birth to an average of nearly eight children. Uganda, Mali and Somalia are close behind, with an average of six to seven children per woman. Each pregnancy increases the risk of complications and death.

"There is a clear connection between countries that have a high fertility rate, where women are having six to seven children, and the maternal mortality rates," Dr. Dorothy Shaw, a clinical professor in obstetrics and gynecology at the University of British Columbia in Canada, told CNN.

In sub-Saharan Africa, where the maternal mortality rate is one of the highest in the world, a woman has a 1-in-16 chance of dying during childbirth. Conversely, for a woman in a developed country, such as the United Kingdom, there is only a 1-in-4000 chance of death. The differences in the maternal mortality rates between rich and poor countries, according to the World Health Organization, are the health indicator of the disparity between the two.

The 10 countries with the highest risk of maternal death, according to UNICEF, are Niger, Afghanistan, Sierra Leone, Chad, Angola, Liberia, Somalia, the Democratic Republic of Congo, Guinea-Bissau and Mali. For every woman who dies, another 20 suffer illness or injury.

The most common causes of maternal deaths, according to UNICEF, are hemorrhaging, infection, obstructed labor, hypertensive disorders during pregnancy and complications from an unsafe abortion. "The root cause," according to UNICEF's annual State of the World's Children Report, "may lie in women's disadvantaged position in many countries and cultures and in the lack of attention to, and accountability for, women's rights."

"Saving the lives of mothers and their newborns requires more than just medical intervention," said UNICEF Executive Director Ann Veneman. "Educating girls is pivotal to improving maternal and neonatal health and also benefits families and societies."

According to Maternity Worldwide, an organization focused on developing maternity services in impoverished countries, "The ability of women to command resources and make independent decisions about their fertility, their health and healthcare also has an impact on maternal mortality."

Where women and girls are afforded a low status in society their health needs are often neglected. Additionally, lack of education and understanding around health-related issues can contribute to delays in seeking care when it is needed or to life-threatening pregnancy complications being inappropriately managed.

In places like rural Africa, women still have little to no control over their reproductive health, although they are well aware of the effects of numerous pregnancies. They also have multiple pregnancies because many of their children die due to newborn complications and childhood diseases. "They realize there's a toll on them, raising six to seven children, going through pregnancy six to seven times," said Powers. "They know they're at risk."

On Oct. 31, the United Nations reported that the world's population reached 7 billion. Fred Pearce, an environment journalist who studies population issues, wrote that women today are having half as many children as their mothers and grandmothers. The global average is now down to 2.5 children per woman, and it continues to fall, he wrote. However, this figure is not accurate for women in countries where they have little control over their reproductive wellbeing.

Research conducted by three U.N. agencies—the World Health Organization, UNICEF and the U.N. Population Fund—showed that in 2000, the maternal mortality ratio, which measures the number of deaths due to pregnancy-related complications per 100,000 live births, was 920 in sub-Saharan Africa, where as in developed countries it was just 20. That same year, based on the U.N. research, world leaders agreed make an effort to slash the number of maternal deaths by 75 percent by 2015.

According to the World Health Organization, the first step in reducing maternal deaths is ensuring that women have access to family planning and safe abortion, which can reduce unwanted pregnancies and women resorting to unsafe abortions.

"In poorer countries, we know women are not seeking to have large numbers of children," said Shaw, former president of the International Federation of Gynecology and Obstetrics. "In many cases, they would like to limit family size. However, they don't have access to effective contraceptive that's affordable and acceptable and available to them."

Women who carry pregnancies to term need proper care for the sake of their health and the health of their babies. Most maternal deaths are avoidable, as the healthcare solutions to prevent or manage complications are well known. Since complications are not predictable, all women need care from skilled health professionals, especially at birth, when rapid treatment can make the difference between life and death. For instance, severe bleeding after birth can kill even a healthy woman within two hours if she is unattended.

The World Health Organization reports that 62 percent of women in developing countries receive assistance from a skilled health worker when giving birth, which means that 45 million women give birth at home without assistance.

For the United Nations Populations Fund (UNFPA), working for the survival of mothers is a human rights imperative. In 2008, UNFPA established The Maternal Health Thematic Fund with the goal of increasing the capacity of national health systems to provide a broader range of quality maternal health services, to reduce health inequities, and to empower women to exercise their rights to maternal health.

UNFPA has teamed up with UNICEF, the World Bank, World Health Organization and UNAIDS to accelerate progress in saving the lives of women and newborns. The team, collectively known as The Health 4+ ("H4+" for short), has pledged to support countries with the highest maternal mortality rates.

In 2010, H4+ joined the Every Woman Every Child effort in order to support to the Global Strategy for Women's and Children's Health's goal of reducing the maternal mortality rates. The agencies have helped countries make commitments to this global initiative, and are supporting a group of countries, which together account for almost 60 percent of global maternal deaths, to mobilize the financial, technical and human resources needed to meet their commitments.

"We are making progress and enhancing our collaboration at all levels," said Laura Laski, chief of UNFPA's sexual and reproductive health branch. "All four agencies are present in 60 countries, have long-standing and good relations with their governments, and can help to ensure that we not only get more money for health, but also more health for the money, by harmonizing and working together."